Making doctors doers

The country is working to ensure surgeons get more clinical experience. Xu Jingxi reports from Guangzhou.

The widely held notion that only the most hands-on medical students can earn doctorates may not be true, a recent study suggests.

An in-house survey of doctoral graduates working in a top-notch hospital in South China found nearly a third don't dare perform night-shift surgeries on their own. They instead wait until morning, when their professors are present.

"China's medical students now have to spend most of their time and energy on research," says First Affiliated Hospital of Sun Yat-sen University's president, Xiao Haipeng.

Residents trained at the First Affiliated Hospital of Sun Yat-sen University check out surgical tools. Photos Provided to China Daily

"They spend so much time performing experiments on mice so they can publish in journals to earn their degrees. Young doctors should place greater emphasis on clinical practice."

Hospitals that teach should establish a training system that meets international standards for residents and specialists, he says.

Graduates' inadequate clinical experience compelled the central government to three years ago establish a national system to standardize residents' training by 2020.

Recent grads must undertake pre-job training at designated hospitals.

For example, graduates with a bachelor's degree need to finish three years of training as a resident.

About 190,000 medical graduates and young residents have taken the training in the past three years.

It's showing results. Over 80 percent of trainees who took the national clinical licensure examination last year passed. That's about 10 percent higher than those without the training, National Medical Examination Center figures show.

The government has given subsidies totaling 12.6 billion yuan ($1.84 billion) to support the initiative since 2014, the National Health and Family Planning Commission says.

Xiao's hospital is Guangdong province's only demonstration base.

It has partnered with the Association for Medical Education in Europe since 2015. British experts host biannual faculty-training courses.

It also pays for surgeons to take the demanding membership examination jointly offered by the Royal College of Surgeons in Edinburgh and the Hong Kong Intercollegiate Board of Surgical Colleges.

Only eight general surgeons from the Chinese mainland have earned the membership. Three are from the First Affiliated Hospital of Sun Yat-sen University.

Tan Jinfu, an associate chief surgeon at the hospital's gastrointestinal department, passed after training at Hong Kong's Queen Mary Hospital. He calls the experience "mind-blowing".

"You have to conduct at least 200 surgeries a year to pass," the 39-year-old says.

"But residents in our hospitals usually conduct 20 to 30. So, young surgeons in Hong Kong have much richer clinical experience than people on the mainland."

This enables them to pass tests like the examination Tan completed.

For instance, they must be able to tell by touch which of the inguinal area's seven layers contains an abdominal mass.

Tan subsequently decided to give his younger subordinates more opportunities to perform solo surgeries.

Han Dayu, a 28-year-old resident who works under Tan, appreciates his mentor's trust.

"He helps me quickly gain the clinical experience I need."

Han never ventures more than 300 meters from the hospital. He's on call for 36 hours during his shifts.

Hong Kong's "hellish" training process of accumulating years of clinical experience before choosing to focus on surgery or research is comparable to those of Europe and the United States, says the hospital's vice-president, Kuang Ming.

"A doctor's clinical abilities are ensured either way," he says.

"They can cultivate medical professionals adept at both clinical practice and scientific research."

Xiao says the First Affiliated Hospital of Sun Yat-sen University seeks to cultivate such talent to propel the development of medicine.

To achieve this goal, the hospital launched the Ke Lin Project in 2015. It selects five fresh grads of Sun Yat-sen University's eight-year clinical medicine program every year and sends them to overseas universities and institutes to conduct research for two years. Each will get 200,000 yuan a year. The project will last for 10 years.

"Doctors who are only capable of great surgery are just craftsmen. The more excellent ones will conduct scientific research to solve the problems they discover on the operating table," Xiao says.

"Such research oriented toward clinical practice can forge breakthroughs in overcoming difficult-to-treat and serious diseases, and truly promote medical science's development."

Contact the writer at xujingxi@chinadaily.com.cn